Fact Sheet: What you can do about anxiety before surgery

Operations can restore your health and even save your life, but it is normal to feel a bit anxious before a surgical procedure, especially the day or two beforehand. Today, more operations are done as day surgery. That means that people go to the clinic or hospital, have the procedure and are then back home the same day.

Is it normal to be anxious?

Fear is a natural reaction. Behind every operation lie many unknowns - especially if it is your first procedure. This is true not only of patients. Family and friends worry too, especially if the operation is a serious one, or when it is a child having the surgery.

Severe anxiety causes unpleasant symptoms. For example, the heart pounds and races, the pulse can be irregular, and there can be nausea and sleeplessness. Sometimes the anxiety itself causes more anxiety, particularly when these symptoms seem to indicate that the illness is getting worse. However these are typical signs of anxiety, and it will not last long.

It is important to know that anxiety will not have an influence on the operation itself or delay waking up after the operation. Anxiety can make it harder, though, to understand and remember important things people tell you, such as advice about what you need to do to recover after the operation. This particularly affects older people.

What can help relieve anxiety before an operation?

Individuals react very differently to fear and stress. Researchers have tested several methods for coping with anxiety before an operation. These include:

• Explanations and information about the operation
• Music
• Sedatives and other anti-anxiety drugs

The results of these trials show that at the moment, there is no one cure-all for anxiety before surgery. The research on many strategies against anxiety before an operation is still in the early stages, so it is not always possible to be really sure if something works or not.

Information

Being informed about the operation is important. Most people want to understand what will happen. The information might come from group talks and meetings, individual counselling, brochures or books, educational packages or films, and from the Internet. Many patients want to know what they might see and feel. They also want to know how to handle these experiences.

But there are also people whose anxiety grows if they hear a lot about the details. Nevertheless, studies show that most patients feel that they do not get as much information as they want. And all in all, trials show that patient education does not increase anxiety, and on average may reduce people's fears.

Relaxation techniques

No particular relaxation technique has been so well tested that we can say what is the most effective at relieving anxiety before surgery. Massage might help anxiety in general, but it has not been tested especially for people having surgery. It is unclear whether other relaxation techniques, hypnosis or humour help reduce fear before an operation.

Music

Music helps many people relax and feel calmer. Overall, the results of trials found that music could reduce anxiety before surgery a bit. After the operation, the patients were less tired, and needed less pain relief.

Medicines

There are also sedatives and medicines to help you sleep the night before the operation. They could also make you less alert on the day of the operation. Trials have shown that there is no major reason to avoid anti-anxiety medicines in day surgery. They do not seem to delay or complicate recovery after the operation.

What helps children, and what can parents do?

Children are now often not admitted to hospital until the actual day of the surgery. Parents are usually then able to stay with their child until he or she is going under anaesthetic. They are also usually allowed to be next to the bed in recovery, so that they are there when the child wakes up. If there is no parent or other support person there, it can increase the child's anxiety.

Parents can also try to help relieve anxiety in their child. Children might be helped by being read to, told stories or drawing pictures of what will happen to them in the hospital, and the machines they will see there. Plays and puppet shows might help too. Some hospitals offer these kinds of entertainment and educational preparation, as well as books or even television programs for children.

© IQWiG (Institute for Quality and Efficiency in Health Care)